Clinical Summary

Syphilis Infection in Pregnant Women: Screening

September 04, 2018

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Population Pregnant women
Recommendation Screen early for syphilis infection in all pregnant women.
Grade: A
Risk Assessment All pregnant women are at risk. All pregnant women should be tested for syphilis as early as possible when they first present to care. If a woman has not received prenatal care prior to delivery, she should be tested at the time she presents for delivery.
Screening Tests Screening for syphilis infection is a 2-step process. The traditional approach is to perform an initial “nontreponemal” antibody test (ie, Venereal Disease Research Laboratory [VDRL] test or rapid plasma reagin [RPR] test), followed by a confirmatory “treponemal” antibody detection test (ie, fluorescent treponemal antibody absorption test or Treponema pallidum particle agglutination test). A newer alternative is the reverse sequence screening algorithm: an automated treponemal antibody test (eg, enzyme-linked, chemiluminescence, or multiplex flow immunoassay) is performed first, followed by a nontreponemal VDRL or RPR test. If the test results are discordant, a second treponemal test is performed.
Treatments and Interventions The Centers for Disease Control and Prevention recommend parenteral benzathine penicillin G for the treatment of syphilis in pregnant women..
Relevant USPSTF Recommendations The USPSTF has made recommendations on screening for other sexually transmitted infections, including chlamydia and gonorrhea, hepatitis B virus, genital herpes, and HIV.

For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to